Provider Demographics
NPI:1023131711
Name:ALAMANCE CASWELL AREA MH DD SA AREA AUTHORITY
Entity type:Organization
Organization Name:ALAMANCE CASWELL AREA MH DD SA AREA AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYRON
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-513-4200
Mailing Address - Street 1:319 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2992
Mailing Address - Country:US
Mailing Address - Phone:336-513-4200
Mailing Address - Fax:336-513-4379
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2992
Practice Address - Country:US
Practice Address - Phone:336-513-4200
Practice Address - Fax:336-513-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL001056261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901663Medicaid
NC07053OtherBLUE CROSS BLUE SHIELD NC
NC3404920Medicaid
NC6005767Medicaid
NC280006Medicare ID - Type Unspecified